angina pectoris

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Angina Pectoris- is recurring acute chest pain or discomfort

resulting from decreased blood supply to the heart muscle(myocardial ischemia). Angina occurs when the heart’s need for oxygen increases beyond the level of oxygen available from the blood nourishing the heart. Angina is a common symptom for coronary heart disease (CHD). The symptoms of angina include mild or severe pain, pressure, or discomfort in the chest, the pain is generally described as a feeling of a squeezing, strangling, heaviness, or suffocation sensation in the chest.

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3 Types of Angina

Stable

Unstable

Variant

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3 Types of Angina Stable

Effort-induced pain from physical activity or emotional stress

Relieved by restPredictable and reproducible

Unstable

Variant

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3 Types of Angina

Stable Unstable

Pain occurs with increasing frequencyDiminishes patient’s ability to workHas decreasing response to therapyMay signal an oncoming MI

Variant

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3 Types of Angina

Stable Unstable Variant

Pain due to coronary artery spasmPain may occur at certain times of the

day, but is not stress induced

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Prinzmetal's Angina

- Prinzmetal’s or variant angina is caused by a vasospasm, a spasm that narrows the coronary artery and lessens the blood flow to the heart.

- Prinzmetal's Angina usually occurs in arteries already narrowed by atherolsclerosis, in fact most people with it have severe coronary atherosclerosis in at least one major vessel. stable and unstable angina, Prinzmetal's Angina usually occurs when  a person is at rest or sleep and not after physical exertion or emotional stress.

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Microvascular Angina  Microvascular angina, or Syndrome X, occurs when the patient experiences chest pain but has no apparent coronary artery blockage. This condition results from poor functioning of the tiny blood vessels that nourish the heart, arms and legs. Microvascular angina can occur during exercise or at rest. Reduced vasodilator capacity of the coronary microvessels is thought to be a cause of angina during exercise, but the mechanism of angina at rest is not known. 

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Symptoms of Angina

Severe chest discomfort (heaviness, pressure, tightness, choking, squeezing)

Sweating Dizziness Dyspnea

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Risk Factors for Angina

Advanced age Coronary artery disease Hypertension Increased serum glucose levels

(diabetes) Increased serum lipoprotein levels Obesity Smoking Type A personality

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Initiating Factors of an Attack Cold weather Emotions Heavy meals Hypoglycemia Pain Smoking

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Discussion

Explain why some of these factors may initiate an angina attack: cold weather, emotions, heavy meals, hypoglycemia, pain, smoking.

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Discussion

Explain why some of these factors may initiate an angina attack.

Answer: cold weather – tension in the muscles, possible decrease in blood flow….

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Nitrates

Most commonly used drugs for angina

Relax vascular smooth muscle and cause vasodilation

Helps with pulmonary edema in CHF

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Agents for AnginaNitrates

isosorbide dinitrate (Dilatrate-SR, Isordil)

isosorbide mononitrate (Imdur, Ismo) nitroglycerin (Minitran, Nitrolingual,

Nitrostat)

Drug List

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nitroglycerin (Minitran, Nitrolingual, Nitrostat) Drug of choice for acute attacks

Spray and tablets taken sublingually May also be used as a prophylaxis If using a patch, it should not

remain on the skin for a full 24 hours, there needs to be free time

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nitroglycerin’s Side Effects Severe headache Orthostatic hypotension Flushing

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nitroglycerin Dispensing Issues

Tablets must be dispensed in the original amber glass bottle

Medication should be refilled every 3 months and discard any remaining drug

Warning!

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Calcium Channel Blockers Relaxes vascular smooth muscle

Some of these drugs should be taken with food and caffeine should be limited

Constipation is most common side effect

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Agents for AnginaCalcium Channel Blockers

amlodipine (Norvasc) bepridil (Vascor) diltiazem (Cardizem, Dilacor XR) felodipine (Plendil) isradipine (DynaCirc)

Drug List

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Agents for AnginaCalcium Channel Blockers

nicardipine (Cardene) nifedipine (Procardia) nisoldipine (Sular) verapamil (Calan, Covera HS,

Isoptin, Verelan)Beta Blockers – Table 12.5

Drug List

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verapamil (Covera HS)

Timed-release product designed for bedtime dose

Drug is pumped out of 2 holes in the tablet

Patients may see a ghost tablet in the stool

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Beta Blockers and Angina Effective in slowing the heart rate,

decreasing myocardial contractility, and lowering blood pressure

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